ADHD Meds

I was hesitant to go on them. It’s funny, because at the time I was smoking half a pack of cigarettes and a non-trivial amount of weed every day. I’d get drunk on the weekends, was sometimes eating McDonalds twice a day, and could easily drink a 2L of Coke in 24 hours.

But, “I don’t want any chemicals fucking with my brain.”

For years I had tried all the methods of getting organized. I wanted it so bad, but nothing stuck. I wish it were for lack of effort. At least then I would have known the path forward. But things got to the point where “try harder” was no longer a viable strategy.

So I decided, “I’ll try the meds for thirty days. If life is better, I’ll stay on them. If life gets worse, I’ll go off.” (Please, please, please don’t go off your meds without talking to your doctor.)

I went to see my family doctor. He said, “There are two kinds of meds you can try for ADHD. Option A (Straterra) builds up in your system and will take about two weeks to kick in. Option B (Ritalin), you’ll notice in 15 minutes.”

I took Option B.

Fifteen minutes later, I was like “Holy shit! Is this what everyone else feels like?” Then I cleaned my apartment for three hours.

It was like putting blinders on to the distractions of the world. All the stuff in my periphery went quiet. For the first time in my life I could make a list of A, B, and C, and actually do it — and in that order.

Life started getting a lot better after that. Within a few weeks my boss asked me what was going on because I had been noticeably more effective. My sleep schedule got marginally better. I started showing up less late to meetings.

I also have Type 2 Bipolar, but was in denial about it at the time. So while the stimulants helped on some days, on others they caused me to focus a lot on how much life sucked. They probably also sent me into hypomanic states — one of the reasons doctors are hesitant to prescribe stimulants to bipolar folks.

So I’d get depressed, and my productivity would drop off, and I’d think, “I must have built up a tolerance.” So my doctor would switch me to something different. I went from Ritalin to Adderrall to Dexedrine, which I still take today. Turns out, it’s like I needed to put five screws and twenty nails into a board but only had a screwdriver, so I just kept banging away on the bigger problem with the wrong tool.

About two years after getting on the stimulants, I finally saw a psych who put me on Lamictal for bipolar, which, as far as I’m concerned, is a wonder drug. With the bipolar properly treated, I was able to drop my Dexedrine from 40mg to 5mg, the lowest dose you can get in the extended release.

The over-simplified theory about brains with ADHD is that they’re optimized for novel and high-pressure situations. During times of stress, it releases lots of dopamine which lets you focus and function abnormally well. In more mundane situations, you have less dopamine than average, making it hard to focus. My rudimentary understanding of the stimulants is that they trick your brain into thinking “Hey! Some high-speed shit is going down right now! Let’s get to work!”

There are things about the stimulants I don’t like. First off, they’re stimulants. I feel my heart start beating faster when they kick in, and coming from a family with history of heart problems, I worry about that.

I feel more machine-like when I’m on them. Sometimes that’s super useful. It’s easier to start working. It’s easier keep working. It’s harder to get distracted. But I also show less interest in people, act more serious, tell fewer jokes, and sing less to myself. For seven years, that trade-off was worth it. I had lots of holes to climb out of and needed all the help I could get to sit at a desk eight hours a day and bang out work.

I was worried that ADHD meds would make me less creative, but if you measure creativity by one’s ability to create, I’m an order of magnitude more creative today than ten years ago. The runaway train of thoughts always felt creative, but I finally came to realize that I wasn’t creating — I was just thinking. Ideas seemed brilliant because they were never tested against the real word. The meds helped me me bring them out of my head and into existence.

For me, the stimulants were a temporary scaffolding providing external support while I built more permanent structure. They were training wheels keeping me from falling over while I learned to keep a to-do list that sticks, how to not drown in email, how to set realistic expectations.

I also shed a lot of crippling guilt. I came to accept that my brain works differently than most — better in some situations and worse in others. Boredom is the enemy. Novel situations are good. High pressure situations are good. Creative situations are good. Situations where I have to perform — where there is nothing left to procrastinate, just this moment — those are good. I’ve since tried to shape my life around the way my brain works instead of constantly jamming it into situations it wasn’t built for.

About two years ago, I stopped taking the Dexedrine every day. I had started doing more public speaking and felt less animated and less spontaneous when I was on them. It was a marginal difference, but it was the first time that it felt like they were hurting me professionally, even just a little bit. By that point I had built up enough habits and confidence to try life without them.

I still keep them around and take them as needed. It probably averages out to five times a month. Now I’ve got this awesome job as developer evangelist where every week looks a little different. I get to travel attend events. I have a ton of control over my schedule and what projects I work on. But, if I notice that my inbox has been at 70+ emails for a while and that my expense reports are six weeks late, then I have no problem taking a Dexedrine and getting to work.

I used to think of meds as a binary thing. Either you were pro-Western medicine, or you hated the lies told by money hungry pharmaceutical companies and wanted none of that artificial crap in your body. Now I look at all meds (and really, all decisions we make in life) as a cost-benefit analysis. What are you getting? What are you giving up?

One in three people with bipolar will attempt suicide. The others live in agony. My Lamictal prevents both of those outcomes and has no noticeable side effects. That’s a pretty huge ROI.

The Dexedrine makes me somewhere between 1.1X and 3X more productive depending on the work that needs to be done that day. It also causes me to feel 10% to 30% less funny, spontaneous and empathetic.

It’s hard to imagine the math ever changing on the Lamictal, but the calculation on the Dexedrine happens on a daily basis. For five years it was a resounding “Yes”, and I have no regrets. Even if I found out that the stimulants shaved five years off of the functional lifespan of my heart, it was probably worth sacrificing quantity of life for quality. For I was finally able to move in the direction of my dreams and close the gap between who I am and who I could be.

These days, it’s mostly a “No”, but I’m grateful to still have the stimulants as a tool in the tool belt.

The correct clinical term is “ADHD”, which encompasses even the non-hyperactive kind, but I still mostly say “ADD” in conversation. ↩